Provided by Clinician 1

The New England Journal of Medicine is a great publication. As a PA I have read and admired it for decades. Because of a number of articles I just read, I wonder how often it gets things “wrong”. Not facts per se, as they can be checked. I know the “Journal” does a great job at that. But about reporting on other things where we do not yet know what the outcomes will be? Recently the Journal reported on two topics; promising research results in cancer treatment and the “primary care shortage”.

Last week a major article (that we at Clinician 1 emailed to you) reported for the first time on a new class of drug called the PARP Inhibitors.  http://content.nejm.org/cgi/content/full/NEJMoa0900212?query=TOC These medications treated cancer that was genetically passed on in the BRCA 1 and 2 genes and in many cases treated it more successfully than ever before. Some researchers have classified it as a breakthrough. Although the clinical trials were only in Stage 1, they were significantly promising. Yet, we still have to wonder what may happen when thousands of people take these products? We all know that many times these trials do not reproduce the same results that looked so rewarding in the earlier stages. Will new side effects appear? All of us hope that in this case the trials are even better than reported and much higher ovarian, breast and prostate cancer cure rates will be common a few years from now. Lofty goals. 

In the same issue there were two editorials both concerned with the primary care shortage. Amazingly one of the editorials which was well thought out titled “A Life Line For Primary Care” there was NO MENTION of PAs or NPs. There was much talk of how to make primary care more financially rewarding and even then, still no talk of NPs or PAs. We all know that good PAs and NPs make the practices that we work in more money so why did they not include that information? Are we that invisible or did they not want to open Pandora’s Box by including us?   http://content.nejm.org/cgi/content/full/360/26/2693. 

To be fair the second editorial mentioned us very positively.  That editorial: “Easing the Shortage in Primary Care - Is It All About the Money” was in some way complementary about NPs and PAs saying that “The way in which primary care practices are organized and collaborations among doctors, nurse practitioners, and physicians’ assistants will be key determinants of the number of physicians needed, their professional experiences, and their job satisfaction. However, merely increasing the numbers of medical schools, medical students, or residency positions that could produce primary care physicians will have limited effects if U.S. medical students continue to shun such careers”.  In my opinion not giving us our fair due, but clearly realizing that we are parts of the future primary care equation.    http://content.nejm.org/cgi/content/full/360/26/2696?query=TOC

A few questions entered my mind about these articles. Which article was more off base; the clinical study or the primary care projections and thoughts? I question how can anyone can have an educated conversation today without the realization that PAs and NPs provide a significant percentage of primary care? How can the first article’s three physician “experts” fail to even bring us up? Do they know we are here? Are they minimizing our roles in keeping America healthy?  In most physician publications few if any researchers have acknowledged our real worth and the fact that there are 100,000 people out there who are providing primary care services who are not physicians. The solutions always come down to producing more physicians, re-paying their loans, importing physicians from other countries, but really never just expanding the use of NPs and PAs. Too much to expect?

I know much more about health policy and primary care than I do new cancer treatments, and that’s what was so scary. If one article was so far off the mark, could the other two articles also really be as correct as I expect them to be? I guess the lesson here is always to beware of what we read. And, whenever we feel minimized, lets let the authors know that NPs and PAs are part of the solution and need to be seen as such. After all, if we don’t let them know they omitted a huge positive solution to the primary care crisis. who will? We can’t control the outcome of the PARP inhibitor research, but you bet we can make ourselves heard about being a solution to the increased provision of all types of care if we get more involved. 

Dave

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